| NPI | 1942692686 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 32568) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 32568) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-03-03 |
| Last Update Date | 2017-09-11 |